LADA mob ntshav qab zib yog dab tsi

Paub tias ntawm qhov tseem ceeb ntshav qab zib hom II lus dag zuj zus insulin kuj (cov nqaij ua tsis tau ntxig rau cov tshuaj insulin) thiab them nyiaj ib ntus nce insulin secretion nrog nws txuas ntxiv thiab nce hauv cov ntshav qab zib. Txawm li cas los xij, cov kws tshawb fawb tsis tuaj yeem nkag siab vim li cas qee tus neeg mob ntshav qab zib hom II, mob ntshav qab zib thiab kev xav tau cov tshuaj insulin tsuas tshwm sim nyob rau hauv ob peb xyoo caum, thaum lwm tus (lawv tus lej muaj tsawg dua) - twb nyob rau hauv ob peb xyoos (txij li 6 lub hlis txog 6 xyoo) Lawv pib nkag siab txog cov cai ntawm hom ntshav qab zib hom II. Los ntawm lub sijhawm no, lub luag haujlwm tseem ceeb ntawm autoantibodies hauv kev txhim kho hom ntshav qab zib hom I twb tau paub (yog tias koj tsis tau nyeem nws, Kuv xav kom koj nyeem nws).

Australian Diabetologist xyoo 1993 luam tawm ua haujlwm nrog qib kawm tau tshuaj tiv thaiv thiab kev zais C peptide nyob rau hauv teb rau stimulation glucagonuas nce qib qab zib.

C-peptide yog qhov cov protein ua me me uas tso tawm los ntawm cov enzymes los hloov cov proinsulin molecule rau hauv insulin. Qib ntawm C-peptide yog ncaj qha sib luag mus rau theem ntawm cov hlab ntsha insulin. Los ntawm kev mloog zoo ntawm C-peptide, ib tus tuaj yeem ntsuas lub qhov zais cia ntawm tus kheej insulin hauv tus neeg mob ntawm cov tshuaj insulin.

C-peptide tseem nyob hauv kev tsim cov tshuaj insulin los ntawm proinsulin.

Kev tshawb nrhiav cov tshuaj autoantibodies thiab kev txiav txim siab txog qib uas raug C-peptide nyob rau hauv cov neeg mob uas muaj ntshav qab zib hom II muab cov txiaj ntsig tsis tiav. Nws muab tawm tias cov neeg mob nrog muaj cov tshuaj tiv thaiv thiab tsis muaj kev zais zoo ntawm C-peptide tsis muaj mob ntshav qab zib hom II (raws li kev soj ntsuam los ntawm tus mob), tab sis yuav tsum yog los ntawm Yam I ntshav qab zib (los ntawm cov tshuab ntawm kev txhim kho). Tom qab ntawd nws tau muab tawm tias lawv xav tau cov tshuaj insulin ntau dua li lwm pab pawg. Cov kev tshawb fawb no tau tso cai rau peb paub qhov sib txawv ntawm cov ntshav qab zib sib luag - "hom 1.5 ntshav qab zib", Uas yog qhov zoo dua paub nyob hauv lus Askiv abbreviation Lada (latent autoimmune mob ntshav qab zib hauv cov neeg laus - latent autoimmune ntshav qab zib hauv cov neeg laus) Latent - zais, tsis pom.

Qhov tseem ceeb ntawm kev kuaj mob LADA

Nws yuav zoo li, dab tsi txawv dab tsi li cov kws tshawb fawb tau los nrog? Vim li cas tsim kev kub ntxhov rau koj lub neej nrog kev kuaj xyuas ntxiv? Tab sis muaj qhov sib txawv. Yog hais tias tus neeg mob TSIS TAU nrog LADA (mob ntshav qab zib sai ntawm cov neeg laus), nws tau kho tsis muaj insulin uas yog hom ntshav qab zib hom II, muab tshuaj noj kom zoo rau lub cev, kev kawm tawm dag zog lub cev thiab txo cov ntsiav tshuaj qab zib los ntawm sulfonylurea pab pawg (glibenclamide, glycidone, glyclazide, glimepiride, glipizide thiab lwm tus). Cov tshuaj no, nrog rau lwm cov teebmeem, txhawb cov roj ntsha insulin secretion thiab txhawb cov beta hlwb, yuam lawv ua haujlwm rau qhov txwv. A siab dua cov haujlwm ua haujlwm ntawm cov hlwb, lawv muaj kev puas tsuaj ntau dua nrog autoimmune o. Tshwm sim vaj huam sib luag vauv:

autoimmune beta cell puas?
txo qis insulin zais?
sau ntawv noj tshuaj txo cov piam thaj?
nce kev ua haujlwm ntawm cov roj hlwb txuas ntxiv?
nce autoimmune o thiab kev tuag ntawm txhua qhov beta hlwb.

Tag nrho cov no rau 0.5-6 xyoos (thaj tsam nruab nrab 1-2 xyoos) xaus nrog pancreatic kev tshem tawm thiab cov kev xav tau kho insulin ntau (siab kawg ntawm cov insulin thiab nquag glycemic tswj nrog kev noj zaub mov nruj heev) Hauv cov ntshav qab zib hom II, xav tau cov tshuaj insulin tshwm sim ntau tom qab.

Txhawm rau txhawm rau tshem tawm lub voj voog ntawm kev tsim kho autoimmune sai, tam sim ntawd tom qab kev kuaj mob ntawm LADA ntshav qab zib, tso cov tshuaj insulin me me. Ntxov tshuaj kho thaum ntxov muaj ntau lub hom phiaj:

muab rau so hauv beta hlwbCov. Qhov ntau yam zais cia, ntau lub hlwb tau puas hauv cov txheej txheem autoimmune,
kev txwv tsis pub muaj tus kabmob autoimmune hauv cov txiav los ntawm txo qhia (mob hnyav thiab ntau npaum li cas) ntawm autoantigens, uas yog "liab khaub ncaws" rau lub nruab nrog cev thiab cuam tshuam cov txheej txheem autoimmune, nrog rau qhov tshwm sim ntawm cov tshuaj tiv thaiv. Hauv kev sim, nws tau pom tias kev tswj hwm lub sijhawm ntev ntawm cov tshuaj insulin nyob rau hauv feem ntau yuav txo qhov nyiaj ntawm autoantibodies hauv cov ntshav,
tswj qab zib li qubCov. Nws tau ntev tau paub tias ntau dua thiab ntev dua cov ntshav qabzib nyob hauv lub cev, sai thiab nyuaj rau ntau yam mob ntshav qab zib.

Ntxov tso tshuaj ntxig rau lub sijhawm ntev ntev yuav cawm nws tus kheej ntawm cov kabmob ua rau lub cev zais cia. Txuag cov tso pa tso quav tseem ceeb heev vim ntau yam:

tswj kev saib xyuas ntawm lub hom phiaj cov ntshav qab zib theem vim ib feem ntawm pancreatic muaj nuj nqi,
txo txoj kev pheej hmoo ntawm hypoglycemia,
tiv thaiv kev txhim kho mob ntshav qab zib thaum ntxov.

Yav tom ntej, tshwj xeeb siv tshuaj tiv thaiv kab mob autoimmune o ua rau ntawm tus txiav. Rau lwm yam kab mob autoimmune, cov hau kev no twb muaj lawm (saib tshuaj Infliximab).

Yuav ua li cas liam LADA?

Lub hnub nyoog pib ntawm LADA yog los ntawm 25 txog 50 xyooCov. Yog tias thaum muaj hnub nyoog li no koj xav tias tsam lossis muaj tus mob ntshav qab zib hom II, nco ntsoov kuaj xyuas qhov seem ntawm LADA cov qauv. Txog 2-15% ntawm cov neeg mob uas muaj ntshav qab zib hom II muaj tus kab mob ntshav qab zib autoimmune mob ntshav qab zib rau cov neeg laus. Ntawm cov neeg mob Ntshav Qab Zib Hom II yam tsis muaj rog LADA muaj li 50%.

Muaj yog "LADA Soj ntsuam kev pheej hmoo ua nplai”, Xws li 5 yam:

Mob ntshav qab zib pib hnub nyoog tsawg dua 50 xyoo.
Mob pib (nce zis> 2 L ib hnub, nqhis dej, poob phaus, tsis muaj zog, thiab lwm yam, hauv qhov tsis sib xws nrog cov tsis muaj asymptomatic).
Lub cev qhov ntsuas ntawm qis dua 25 kg / m 2 (hauv lwm cov lus, qhov tsis muaj lub cev nyhav thiab rog dhau).
Cov kab mob autoimmune tam sim no los yog yav dhau los (rheumatoid mob caj dab, mob caj dab lupus erythematosus thiab lwm yam mob rheumaticntau yam sclerosis Hashimoto autoimmune thyroiditis, diffuse toxic goiter, autoimmune gastritis, Crohn's disease, ulcerative colitis, autoimmune pancreatitis, autoimmune bullous dermatosis, kab mob celiac, cardiomyopathy, myasthenia gravis, qee qhov vasculitis, pernicious (B12 - folic deficiency) anemia, alopecia areata (do hau), vitiligo, autoimmune thrombocytopenia, paraproteinemia thiab lwm tus).
Lub xub ntiag ntawm cov kabmob autoimmune hauv cov txheeb ze nyob ze (cov niam txiv, cov pog yawg, cov menyuam, cov kwv tij thiab cov muam).

Raws li cov neeg tsim ntawm cov nplai no, yog cov lus teb zoo txij 0 txog 1, qhov tshwm sim ntawm qhov muaj LADA tsis dhau 1%. Yog tias muaj 2 lossis ntau dua cov lus teb, qhov kev pheej hmoo ntawm LADA yog hais txog 90%, hauv qhov no, yuav tsum muaj kev kuaj sim kuaj.

Yuav ua li cas kom paub meej tias kuaj mob?

Kev kuaj mob kuaj pom tus kab mob latent autoimmune ntshav qab zib hauv cov neeg laus siv 2 txoj kev kuaj mob tseem ceeb.

1) Kev txiav txim siab qib anti-gadget — glutamate decarboxylase cov tshuaj tiv thaivCov. Qhov tshwm sim tsis zoo (i.e., qhov tsis muaj cov tshuaj tiv thaiv rau glutamate decarboxylase hauv cov ntshav) tshem tawm LADA. Cov txiaj ntsig tau zoo (tshwj xeeb tshaj yog muaj cov qib siab ntawm cov tshuaj tiv thaiv) hauv feem ntau (!) Cov kab mob hais lus txaus siab ntawm LADA.

Ib qho ntxiv, tsuas yog los twv seb kev nce qib ntawm LADA tuaj yeem txiav txim tau ICA — Cov tshuaj tiv thaiv rau cov islet hlwb txiav Lub xub ntiag ib txhij ntawm anti-GAD thiab ICA yog cov xeeb ceem ntawm daim ntawv ntau dua ntawm LADA.

2) Cov Ntsiab Lus peptide theem (ntawm qhov khoob thiab tom qab stimulation) C-peptide yog ib yam khoom tsim tawm los ntawm insulin biosynthesis thiab yog li nws cov ntsiab lus yog ncaj qha rau cov theem ntawm cov tshuaj insulin endogenous (intrinsic). Txog ntshav qab zib hom I (thiab rau LADA ib yam nkaus, vim tias LADA yog subtype ntawm type I diabetes) yog tus yam ntxwv txo theem ntawm C-peptide.

Rau kev sib piv: muaj ntshav qab zib hom II, ua ntej pom insulin kuj (cov ntaub so ntswg ua haujlwm rau insulin) thiab compensatory hyperinsulinemia (txhawm rau kom txo cov ntshav qabzib, cov kua zais zais zais insulin ntau dua li ib txwm muaj), yog li ntawd, muaj ntshav qab zib hom II, qib C-peptide tsis txo.

Yog li, thaum tsis muaj qhov tawm tsam GAD, kev kuaj mob ntawm LADA raug txiav txim. Nyob rau ntawm qhov kev tiv thaiv GAD + qib qis ntawm C-peptide, kev kuaj mob ntawm LADA yog suav tias yog cov khoom pov thawj. Yog tias muaj kev tawm tsam GAD, tab sis C-peptide yog ib txwm, yuav tsum tau soj ntsuam ntxiv.

Nrog kev kuaj mob tsis sib haum, LADA qhia tau qhov siab ntawm qhov muaj qhov tsis muaj tseeb caj ces cim cim mob ntshav qab zib hom I (kev tiv thaiv mob siab HLA alleles), vim tias hom kev sib txuas tsis tau pom hauv ntshav qab zib hom II. Ntau zaus, muaj kev sib txuas nrog B8 HLA antigen, thiab yuav luag tsis muaj kev sib raug zoo nrog cov "tiv thaiv" HLA-B7 antigen.

Cov kab mob ntshav qab zib hom I

Muaj 2 subtypes ntawm hom I mob ntshav qab zib mellitus:

hluas ntshav qab zib (cov menyuam yaus thiab cov hluas) = subtype 1a,
subtype 1b, qhov no siv tau Lada (mob latent autoimmune ntshav qab zib hauv cov neeg laus). Cais idiopathic Yam I ntshav qab zib.

Hluas rau ntshav qab zib (subtype 1a) tso nyiaj rau 80-90% ntawm cov neeg mob ntshav qab zib hom I. Nws yog vim lub cev tiv thaiv kab mob tsis haum tus neeg mob. Nrog subtype 1a, tus naj npawb ntawm cov kabmob (Coxsackie B, mob pob zeb me, adenoviruses thiab lwm tus) tsim kev puas tsuaj rau cov kab mob ntawm cov txiav ua ke. Hauv kev teb, lub hlwb ntawm cov tshuaj tiv thaiv kab mob ua kom puas rau cov hlwb cuam tshuam ntawm lub pancreatic islets. Autoantibodies rau islet cov ntaub so ntswg ntawm tus txiav (ICA) thiab kom insulin (IAA) mob hauv cov ntshav thaum lub sijhawm no. Tus naj npawb ntawm cov tshuaj tiv thaiv (titer) hauv cov ntshav maj txo zuj zus (lawv tshawb pom hauv 85% ntawm cov neeg mob thaum pib mob ntshav qab zib thiab tsuas yog 20% tom qab ib xyoos). Cov subtype no tshwm sim li ob peb lub lis piam tom qab kis kab mob hauv cov menyuam yaus thiab cov neeg hluas hnub nyoog qis dua 25 xyoos. Pib yog cua daj cua dub (cov neeg mob tau txais kev saib xyuas hnyav hauv ob peb hnub, uas lawv tau kuaj pom). Ntau zaus muaj HLA antigens B15 thiab DR4.

Lada (subtype 1b) tshwm sim hauv 10-20% ntawm cov neeg mob ntshav qab zib hom I. Qhov subtype ntawm cov ntshav qab zib no tsuas yog ib qho kev pom ntawm cov txheej txheem autoimmune hauv lub cev thiab vim li no feem ntau ua ke nrog lwm cov kab mob autoimmune. Nws tshwm sim ntau dua rau cov poj niam. Autoantibodies nthuav tawm hauv cov ntshav thoob plaws hauv tag nrho lub sijhawm, lawv cov titer (qib) tas li. Cov no yog cov tshuaj tiv thaiv GAD los tiv thaiv glutamate decarboxylase, txij li IA-2 (cov tshuaj tiv thaiv rau tyrosine phosphatase) thiab IAA (rau insulin) yog qhov tsis tshua muaj. Qhov subtype ntawm cov ntshav qab zib no vim yog qes ntawm T-suppressors (ib hom lymphocyte uas suppresses lub cev tsis haum tawm tsam antigens ntawm lub cev).

LADA-ntshav qab zib los ntawm kev siv zog ntawm kev tshwm sim hais txog mob ntshav qab zib hom I, tab sis nws cov tsos mob zoo li mob ntshav qab zib hom II (qeeb pib thiab kawm piv nrog ntshav qab zib hluas). Yog li, LADA-ntshav qab zib yog txiav txim siab nyob nruab nrab ntawm hom I thiab ntshav qab zib hom II. Txawm li cas los xij, kev txiav txim siab txog theem ntawm autoantibodies thiab C-petid tsis suav nrog hauv cov npe ib txwm kuaj mob ntawm ib tus neeg mob uas nyuam qhuav muaj ntshav qab zib, thiab kev kuaj mob ntawm LADA yog muaj tsawg heev. Ntau zaus, qhov sib txuas nrog HLA antigens B8 thiab DR3 tau sau tseg.

Ntawm idiopathic hom kuv mob ntshav qab zib mellitus tsis muaj qhov ua rau lub cev puas tsuaj autoimmune ntawm cov beta hlwb, tab sis tseem muaj qhov txo qis hauv lawv txoj haujlwm nrog kev txiav tawm ntawm cov kua dej tsis zais. Ketoacidosis tsim tawm. Idiopathic mob ntshav qab zib feem ntau nyob rau cov neeg Asxis thiab Asmeskas thiab muaj cov cuab yeej cuab tam tseeb. Qhov xav tau kev kho tshuaj insulin hauv cov neeg mob ntawd yuav tshwm sim thiab ploj mus raws sijhawm.

Los ntawm cov kab lus tag nrho nws yog ib qho tsim nyog kom nco ob peb qhov tseeb.

LADA ntshav qab zib yog me ntsis paub ntawm cov kws kho mob (lub sij hawm tau tshwm sim hauv 1993) thiab yog li ntawd tsis tshua pom muaj kev kuaj mob, txawm hais tias nws pom nyob hauv 2-15% ntawm cov neeg mob ntshav qab zib hom II.
Cov kev ua haujlwm tsis zoo nrog cov ntsiav tshuaj muaj piam thaj ua rau muaj qhov nrawm nrawm (kwv yees li 1-2 xyoos) txo cov hnoos qeev thiab tshem tawm kom tsis txaus siab rau cov tshuaj insulin.
Kev noj tshuaj insulin thaum ntxov pab ua rau kev tiv thaiv qhov mob ntawm cov txheej txheem autoimmune thiab tswj nws tus kheej cov tshuaj insulin kom ntev ntev dua.
Khaws cov tshuaj insulin zais cia ua kom cov ntshav qab zib thiab tiv thaiv kev mob hnyav.
Yog tias koj kuaj pom muaj tus mob ntshav qab zib hom II, kuaj koj tus kheej rau 5 nqe lus piav txog ntshav qab zib LADA.
Yog tias 2 lossis ntau tus qauv muaj txiaj ntsig zoo, LADA mob ntshav qab zib feem ntau yuav tsum thiab C peptide thiab tshuaj tiv thaiv rau glutamate decarboxylase (anti-GAD) yuav tsum tau sim.
Yog tias tiv thaiv GAD thiab qib qis C-peptide (hauv qab thiab tsa) pom, koj muaj latent autoimmune cov neeg mob ntshav qab zib (LADA).